Oregons Health CO-OP | SiMPLEsilver Select Network

SiMPLEsilver Select Network is an Obamacare health insurance plan offered by Oregons Health CO-OP that is available for individuals and families.

This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

This plan is a Silver metal level plan, which generally has a mid-level monthly cost and deductible (and co-pay), and provides middle-of-the-road insurance coverage for people who occasionally use their health care benefits (doctors, prescription drugs, etc.).

Deductible amount of Not Applicable. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

Max out-of-pocket of $6,850, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.

Who is this plan for?

This plan with a moderate monthly cost is great for individuals and families who occasionally visit the doctor or use prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a more broad provider network.

HealthCare.com is a privately-held internet start-up for healthcare consumers. We’re not the government website.

Highlights

Dental Coverage:

Child

Emergency Room:

$500

Retail Drugs:

$70

Generic Drugs:

$15

Overview

Plan Type:

PPO

Metal Level:

Silver

Health Spending Account:

No

Primary Care Office Visit:

$35

Specialist Office Visit:

$55

Out of Network Coverage:

No

Out of Country Coverage:

No

Coverage Details

Preventive Care

Periodic Health Exam

In Network:

No Charge

Out of Network:

Not Covered

Well Baby Care

In Network:

No Charge

Out of Network:

Not Covered

Inpatient

Hospital Services

In Network:

$5,000 Copay per Stay

Out of Network:

50%

Physician Fee

In Network:

No Charge

Out of Network:

50%

Skilled Nursing Facility

In Network:

$3,000 Copay per Stay

Out of Network:

50%

Mental Health

In Network:

$5,000 Copay per Stay

Out of Network:

50%

Substance Abuse

In Network:

$5,000 Copay per Stay

Out of Network:

50%

Home Healthcare

In Network:

No Charge

Out of Network:

50%

Outpatient

Surgery

In Network:

No Charge

Out of Network:

50%

X-ray and Diagnostics

In Network:

$50

Out of Network:

50%

Labs

In Network:

$50

Out of Network:

50%

Facility Fee

In Network:

$4,600

Out of Network:

50%

Mental Health

In Network:

$35

Out of Network:

50%

Substance Abuse

In Network:

$35

Out of Network:

50%

Rehabilitation Services

In Network:

$35

Out of Network:

50%

Maternity/Pregnancy

Pre & Postnatal Care

In Network:

No Charge

Out of Network:

Not Covered

Labor and Delivery Inpatient Services

In Network:

$5,000

Out of Network:

50%

Dental

Accidental Care

In Network:

$500

Out of Network:

$500

Dental Checkup (Child)

In Network:

Not Covered

Out of Network:

Not Covered

Vision

Eye Exam (Child)

In Network:

No Charge

Out of Network:

Not Covered

Glasses (Child)

In Network:

No Charge

Out of Network:

Not Covered

Additional Coverage

Chiropractic Care

In Network:

$35

Out of Network:

Not Covered

Habilitation Services

In Network:

$5,000

Out of Network:

50%

Rehabilitation Services (Speech)

In Network:

$35

Out of Network:

50%

Rehabilitation Services (Occupational Therapy)

In Network:

$35

Out of Network:

50%

Hospice Service

In Network:

No Charge

Out of Network:

50%

Diabetes Care Management

In Network:

$35

Out of Network:

50%

Durable Medical Equipment

In Network:

$70

Out of Network:

Not Covered

Hearing Aids

In Network:

$70

Out of Network:

Not Covered

Nutritional Consuleling

In Network:

$55

Out of Network:

50%

Cosmetic Surgery

In Network:

$5,000

Out of Network:

50%

Reconstructive Surgery

In Network:

$5,000

Out of Network:

50%

Doctor Visits

Primary Care Visit

In Network:

$35

Out of Network:

Not Covered

Specialist Visit

In Network:

$55

Out of Network:

50%

Other Practitioner Office Visit

In Network:

$35

Out of Network:

50%

Preventative Care / Screening / Immunization

In Network:

No Charge

Out of Network:

Not Covered

Emergency Room and Urgent Care

Emergency Room Services

In Network:

$500

Out of Network:

$500

Urgent Care Services

In Network:

$75

Out of Network:

50%

Ambulance/Transportation Services

In Network:

$250

Out of Network:

50%

Drugs

Generic Prescription

In Network:

$15

Out of Network:

Not Covered

Retail Brand Drugs

In Network:

$70

Out of Network:

Not Covered

Non Retail Brand Drugs

In Network:

$140

Out of Network:

Not Covered

Specialty Drugs

In Network:

50%

Out of Network:

Not Covered

Additional Plan Information

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only.
Your monthly premium may change based on the data provided, outside fees, optional benefits
or if other factors take effect before your coverage start date. Note that insurance companies
reserve the right to change your premium rate and the policy terms at any time. Effective date,
benefit amounts and other conditions may apply at the discretion of the insurance carrier you select.
Depending on your state of residence, this website may not display all plans available by state.
The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy
eligibility may differ. Access to your physician depends on network selected, and networks can
change without notice. Contact your health insurance company to confirm your healthcare provider
is still available in the network you select.